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For Dementia Agitation, Atypical Antipsychotics Offer Some Benefit
Atypical antipsychotics offer modest benefit in improving neuropsychiatric symptoms in adults with dementia, but they also carry risk, researchers wrote in a study published online in European Neuropsychopharmacology.
The systematic review and meta-analysis, which focused on the benefits and long-term harms of atypical antipsychotics in adults with dementia, included a previous systematic review and data from 8 randomized controlled trials and 12 large observational studies.
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Aripiprazole, risperidone, and olanzapine led to modest neuropsychiatric symptom improvement, compared with placebo, according to the findings. Quetiapine, however, did not.
On the safety side, aripiprazole, risperidone, quetiapine, and olanzapine were linked with increased odds of myocardial infarction, according to the study. Risperidone and olanzapine were also associated with increased risk of hip fracture.
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Across atypical antipsychotics, researchers found no differences in all-cause mortality. Compared with conventional antipsychotics, atypical antipsychotics were linked with a lower risk of all-cause mortality and extrapyramidal symptoms. The risk of stroke, however, was higher with atypical antipsychotics.
“To manage agitation in adults with progressive dementia, clinicians may recommend atypical antipsychotics with continuous monitoring of behavioral symptoms,” researchers wrote, “informing patients and their families or caregivers of the significant risk of adverse effects and baseline risk of acute myocardial infarction and bone fractures.”
—Jolynn Tumolo
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